RE: RNS27 Oct 2021 11:44
Stu485, you ask:
"Looking at the BRii news release for progression from Active P2 to P3, there is content regarding efficacy.Why do you think in stark contrast Synairgen makes no reference to efficacy ?
Is it possible in the Synairgen case, consideration was made on trial safety and supported by the "growing evidence" referenced in the Synairgen RNS ,of likely efficacy from other studies trials but not specifically Active ?"
I think the answer can be found in Synairgen's RNS, which was much briefer than BRII's release. They said ".... the external data safety monitoring board (DSMB) of the ACTIV-2 study has recommended that SNG001 advance into Phase 3 ...." In the protocol of Activ-2 recently published it's clear that there is a Trial Oversight Commitee (TOC) who make the decisions, based on recommendations from the data safety monitoring board (DSMB). In the "regimen" of the "schema" (page 15) which sets out the general overview of the study, it says "Investigational agents will be included in phase III evaluation based on agent entry criteria for phase III as outlined in the protocol (or by TOC approval based on data available outside of ACTIV-2)." Thus there are two options for progression to phase 3, the first is " based on agent entry criteria for phase III as outlined in the protocol ". The second possibility is that the TOC approves it "based on data available outside of ACTIV-2". Under the second scenario, it seems that it is the TOC who decides without reference to the DSMB, as the DSMB are only there to assess the data from the Activ-2 trial itself.
This is further clarified In the main body of the protocol on page 29-30 which says "The DSMB will review unblinded data and make recommendations to NIAID (as trial sponsor) and to the TOC, indicating whether graduation criteria have been
met (see below for criteria). The recommendation for an agent to enter phase III evaluation will be made by the TOC in discussion with the company...." and then "The TOC may recommend an agent move directly into phase III, without evaluation in phase II in ACTIV-2, if there is sufficient safety and efficacy data supporting phase III evaluation available from outside of the trial. These agents will not undergo graduation analyses."
Since Synairgen stated in their RNS that it is the DSMB who recommended progression to phase 3, it seems clear that there was safety and efficacy seen in the Activ-2 trial itself, as then explained under "Criteria for Graduation of an Agent from Phase II to Phase III" - "Graduation of an investigational agent from phase II to phase III evaluation will be based on there being a desired level of evidence of an effect of an investigational agent versus placebo on one or more virologic and clinical outcome measures, as well as safety...."
The only caveat is that the efficacy required for progression is EITHER a lower level of the virus detected in samples taken, OR an improvement in symptoms, we cannot be sure wh